Screening as the first line of defense

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    Cancer is one of the most feared diseases. In the past, such a diagnosis would have been considered a death sentence. However, advances in the field of medicine have made cancer less threatening than it was, more so if the disease was detected at its initial stage.

    This has made screening and detection one of the most powerful tools doctors have in the fight against cancer. Through different screening techniques, tumors can be found and treated before it can metastasize and lead to further complications. Today, cancer patients in the early stages of the disease can still live long and fulfilling lives.

    Colorectal cancer is one the most prevalent forms of cancer, being the 3rd most common cancer in Filipinos. This is despite it being one of the most treatable and preventable cancers. However, the fight against the world’s second deadliest cancer is an uphill battle in the Philippines. The lack of a national population-based colorectal cancer screening program and the financial burden of screening on the patient are barriers to this campaign.

    The standard screening test for colorectal cancer is a colonoscopy, which not everyone can afford while others are uncomfortable with undergoing an invasive procedure. The pandemic has also made it risky for people to go out and visit hospitals.

    Because of this, a stool test called a fecal immunochemical test (FIT) is a good screening alternative. It detects only human blood and is specific for bleeding in the colon. The test is repeated every year if the initial test is negative. If the test is positive, a colonoscopy is needed to rule out the presence of cancer. In pandemic times, the FIT may be used to stratify patients as to who need the colonoscopy more urgently than others, given the more limited health resources in the country during these times.

    The FIT could also prove to be a more effective way to do a large-scale screening program here. With no hospital visits and needing only stool specimens to run the test, FIT can be deployed on a larger scale, allowing for more coverage, especially in areas where colonoscopies are not available.

    Doctors recommend that screening be done regularly, with it starting at the age of 50. For people with additional risk factors and with a first-degree relative with history, doctors recommend that screening be done earlier, at 40 years old. Age is the most common risk factor for this cancer, as 90 percent of colorectal cancer occurs after the age of 50. A family history of a first-degree relative with CRC is increased two to three-fold. Other risk factors include cigarette smoking, alcohol consumption, obesity, lack of exercise, and poor diet.